Work Experience Placement Registration Form

We require the submission of a completed form for each student prior to the first date of the placement.
Please don't hesitate to contact us if you have any queries.

Privacy Information

We use the information given on this form in order to process your application for work experience with Mane Chance Sanctuary.
We will only use your information to provide the service which you have requested and for closely related purposes. For example, we might contact people to promote other Mane Chance Sanctuary events which we think may be of interest.
At the end of your involvement with Mane Chance Sanctuary, your emergency contact and medical information will be removed from our records. Your personal details may be retained for correspondence purposes, such as the sending out of newsletters, unless you tell us that you would like them removed.
We will never share your information with any third parties for marketing purposes and all information about you is held safely and securely.
In the event of a medical emergency, it may be necessary to share any relevant medical information with healthcare professionals such as ambulance or hospital staff to ensure correct treatment.
For further information on how your details are stored and used, how we maintain the security of your information and your rights to access information we hold about you, please contact us.

Student Details

Full Name of student *

Dates of work placement *

Date of birth of student *

Address of student

Contact phone number *

Contact email address *

Emergency contacts

Please provide us with the name and contact number of at least one emergency contact.

Name of first emergency contact *

Phone number of first emergency contact *

Name of second emergency contact

Phone number of second emergency contact

Medical Information

Please tell us of any allergies or special medical considerations that will ensure that the time spent at the Sanctuary is as beneficial as possible: This information will allow us to:

safeguard you to our maximum ability (information may include any mental health challenges or diagnoses as well as physical conditions)
protect you to our maximum ability from anything they may be allergic to
give the best information to any medical professional (for example ambulance personnel) should their assistance ever be required

If no allergies or medical considerations, please enter none.

University/College Information

Name of university/college attended *

Name of course being studied *

Year of course currently studying eg first year, second year etc *

Disclaimer

Working with horses and handling horses can be dangerous. Horses may be unpredictable and volunteers working at the sanctuary do so at their own risk. I acknowledge that I am responsible for my own safety when volunteering on site.
The Sanctuary will not be held responsible for any direct or indirect accident, injury or loss arising from or in connection with my volunteering activities at the Sanctuary (except in instances of death or personal injury caused by the Sanctuary’s negligence). I waive all and any claims against Mane Chance Sanctuary in this respect.
I acknowledge that I am responsible for my personal effects and that Mane Chance Sanctuary will not be liable for any direct or indirect loss or damage to said effects arising from or in connection with my volunteering activities at the Sanctuary. I waive all and any claims against Mane Chance Sanctuary in this respect.
Whilst volunteering I agree that I will act in accordance with the specific safety instructions that I received on my induction and will follow any safety guidance given to me by the on-site staff.
I understand that it is my responsibility to come to the farm wearing both clothing and footwear suitable for the tasks I shall undertake on site.
I understand that volunteering at Mane Chance Sanctuary requires a moderate level of fitness and is physically testing. I confirm that I have disclosed any medical condition that I suffer from which might have the effect of making it more likely that I will be involved in an accident which could result in injury to myself or others.

I confirm that I am eighteen years old or over.

I confirm that I have read the above disclaimer and agree to the terms stated

Photo permission

Mane Chance Sanctuary sometimes takes photographs or video film for publicity purposes. These images may appear in our printed publications, on our website or social media channels. We may also send them to the news media. We would be grateful if you could complete the questions below to indicate if you give permission for us to do so.

Printed Publicity or Literature

Yes No

Website and social media

Yes No

News media including local press

Yes No

I understand that websites and other media can be seen throughout the world, and not just in the United Kingdom where UK laws apply

Contact preferences

We would like to send you the latest Mane Chance news about all that is happening at the Sanctuary, including other community sessions, our events and how you can help. If you are happy for us to contact you, please tick the box below.
You have the right to withdraw your consent at any time. For more information on how we use your personal information please see our Privacy Notice or contact us for a copy.

Please tell us if you are happy to be contacted

Yes No

Terms and Conditions

Please tick the box to confirm that you have read and accept the Terms and Conditions of Work Experience Placements which have been sent to you. If you would like to read them online, please click here.

I accept the Terms and Conditions of Work Experience Placements

Thank you for completing this form.

Please click submit to send us the information.

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